SHM Converge Scientific Abstract ePoster Gallery-Recurrent Transfusions Hiding a Secret

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This poster describes a 75-year-old man with diabetes, atrial fibrillation, and hypertension who presented with severe recurrent anemia and weakness. Over the prior year, he had required more than 20 blood transfusions. Initial evaluation showed normocytic anemia with marked reticulocytopenia, but extensive workup was unrevealing: iron, vitamin, hemolysis, stool blood, infectious, plasma cell, imaging, endoscopic, and first bone marrow studies did not identify a cause. He was later found to have markedly elevated inflammatory markers and a high ANA titer (1:1280), though additional autoimmune testing was negative. Hydroxychloroquine was tried without benefit.<br /><br />Because anemia persisted, a repeat bone marrow biopsy was performed and revealed pure red cell aplasia (PRCA), characterized by absent or markedly reduced erythroid precursors. Hydroxychloroquine was stopped, and the patient was treated with cyclosporine 200 mg twice daily plus weekly intravenous dexamethasone. Over the following months, cyclosporine was tapered and steroids discontinued, and he no longer needed transfusions. His hemoglobin normalized and symptoms improved significantly.<br /><br />The discussion highlights that PRCA is a rare disorder that should be considered in patients with isolated anemia, low reticulocyte counts, and normal white blood cell and platelet counts. Diagnosis depends on bone marrow findings, although repeat biopsy may be necessary, as in this case. PRCA can be associated with autoimmune disease, infections, thymoma, medications, and hematologic disorders. The poster emphasizes the importance of recognizing PRCA early and initiating immunosuppressive therapy to prevent prolonged transfusion dependence.

Asset Subtitle

Lillian Sangha

Meta Tag

Author List Benjamin Ravichander, Irina Mishagina, Lillian Sangha, Venkataraman Rajagopalan

Category Clinical Vignettes

Concept Pure Red Cell Aplasia

Concept Anemia

Concept Reticulocytopenia

Concept Bone Marrow Biopsy

Concept Erythroid Precursors

Distinguished Non-Finalist

Presenter Organization UPMC Harrisburg

Presenting Author Lillian Sangha

Track Adult

Keywords

pure red cell aplasia

PRCA

recurrent anemia

reticulocytopenia

bone marrow biopsy

transfusion dependence

cyclosporine

hydroxychloroquine

autoimmune disease

immunosuppressive therapy

Pure Red Cell Aplasia

Anemia

Reticulocytopenia

Bone Marrow Biopsy

Erythroid Precursors